There are two types of codes involved in claiming: return codes and reason codes.

Return codes are 4 digit codes that given when there is an issue in the submission of the claim to Medicare. These codes are automatically generated by the gateway of the channel and generally indicate an issue with how the information is being sent.

A return code also includes a message about why the claim was rejected or how it was assessed by the gateway. This information allows you to to identify any claiming errors, make corrections and potentially re-submit the claim(s). There are 764 codes to date.

Reason codes are 3 digit codes that are given when the claim has passed the gateway and has been assessed by the claiming team, either automatically or through manual intervention by an operator. This generally indicates an issue with the information that was sent.

Reason codes are used in processing reports and in the Medicare statement of benefits, and are similar to return codes in that they also provide a message about how a claim was assessed. This can range from scenarios such as the use of an incorrect Medicare Benefits Schedule (MBS) item, issues with eligibility of patients or health professionals to the need for extra details to assess the claim. There are 297 codes to date.

To help you with addressing rejected claims, we've put together a table of Return and Reason codes you may experience and steps you can take to address them.

Return Codes - 4 Digit Codes

Code

Description

Steps to Resolve

1006

PKI login failure.

Possible problem with PKI certificates installed. Certificates may have expired or another problem has been identified. Upload your PKI certificates once more. If error persists, contact Medicare directly

Related to the certificates - please check with Medicare what has been uploaded

1712

HTTP server error

Refresh page Sign out and sign back into MediRecords Check internet connection (Recommended download speed is 18mbps) If problem persists, contact MediRecords Support on 1300 103 903 or email support@medirecords.com

2016

No service exists in the claim for the supplied service ID

Please re-submit and ensure that the items are included.

2030

The data element being set is inconsistent with other data elements already set OR a data element has been set and a related conditionally required data element has not been set.

Two or more pieces of information within the claim cannot be submitted together. Please review and re-submit.

2032

The maximum number of services allowable for the voucher has been reached

The maximum amount of items to be claimed in one invoice in 14. Please submit another claim if exceeding this amount.

2038

The referral/request type is inconsistent with the service type set for this claim

Please check details of the claim, amend and re-submit.

3003

The Medicare server is not operational. Try again later. If the problem persists, contact the Medicare eBusiness Service Centre.

Contact Medicare regarding claim submission.

3004

The request cannot be dealt with at this time because real-time processing is not available or the system is down. Contact the Medicare eBusiness Service Centre for further assistance.

Check the status pages for Medicare, as the server may be down.

3013

The signing Location is unknown. For further assistance contact the Medicare eBusiness Service Centre.

Check that your Minor Site ID/Location Code has been registered appropriately.

3021

The sending Location could not be identified at the Server. Contact the Medicare eBusiness Service Centre for further assistance.

Check RA number and HSS (Minor ID) number with Medicare is registered correctly for this site. Also check that practitioner Provider Numbers are registered correctly against the Minor ID number

3029

HTTP redirection attempted

Check internet connection and try again.

3031

The server cannot fulfil this request

Check your internet connection. Also check Medicare status.

5010

The subscription ID supplied has been identified as in-active

Check if provider number of servicing practitioner is valid.

8005

The individual has been matched using the submitted data however differences were identified. Please check the information returned and update your records.

After OPV check, hover your cursor over the OPV button in the patient file to see what details are listed with Medicare, and edit the patient record accordingly.

9003

The provider is identified as inactive for Online Claiming purposes. Contact the PKI Customer Service Centre for assistance.

Provider must check their provider number registered with Medicare.

9006

The Provider is not authorised to participate in Online Claiming. Contact the Medicare eBusiness Service Centre for further assistance.

Check servicing provider details, as they may not be eligible to provide service for this item at the date of service. For more information, contact eBusiness.

9007

The Location is not authorised to undertake the function on the date of transmission. The transmission has been rejected. Contact the Medicare eBusiness Service Centre for further assistance.

Check practice and provider eligibility to bill for service - contact Medicare.

9119

The provider is identified as inactive for Online Claiming purposes. Contact the PKI Customer Service Centre for assistance.

Check provider registration with Medicare.

9120

The Individual Certificate used has been revoked by the Registration Authority. Contact PKI Customer Service Centre for assistance.

Contact eBusiness.

9201

Invalid format for data item

Some required information is missing or has been entered incorrectly. Please check all details being submitted.

9202

Invalid value for data item. The data element does not comply with the values permitted or has failed a check digit check.

There are discrepancies with the data being sent to Medicare for that claim, which may be due to patient details (e.g. address), the provider (e.g. provider number) and/or the item number(s) submitted. Please check all details and ensure no miscellaneous characters are used.

9204

Date in future. The date supplied must not be in the future

Please review service dates on claim and re-submit.

9301

Patient's Medicare card number must be supplied

Please check detail on patient file, run OPV check and re-submit.

9302

Patient's reference number must be supplied

Please check detail on patient file and re-submit.

9303

Patient's first name must be supplied

Please check detail on patient file and re-submit.

9304

Patient's family name must be supplied

Please check detail on patient file and re-submit.

9305

Servicing Practitioner's Provider Number must be supplied

Please check claim and provider number listed, and resubmit.

9306

Date of service must be supplied

Please check claim and re-submit.

9307

An item number must be supplied for each service

Please check item numbers on claim and re-submit.

9308

Referring Practitioner's Provider Number must be supplied

Please amend referring provider information and re-submit.

9309

Referral issue date must be supplied, and must be prior to, or the same as, the date of the medical service, cannot be before the date of birth, nor after the referral start date

Please check the referral/request date entered.

9310

Requesting Practitioner's Provider Number must be supplied

Please amend requesting provider information and re-submit.

9311

Request issue date must be supplied, and must be prior to, or the same as, the date of the medical service and cannot be before the date of birth

Please check the referral/request date entered.

9312

Claimant first name, family name, date of birth, claimant Medicare card number and reference number must be supplied. If any one data element is supplied, then all five (5) must be supplied.

Please check all details listed on the patient file are listed correctly before re-submitting the claim again.

9316

The Referring/Requesting Provider cannot be the Servicing or Principal Provider

Please ensure the same provider is not listed for both, amend claim and re-submit.

9322

Referral period details must be supplied

Please check the referral/request date and other details entered.

9338

A required charge amount has not been supplied or is inconsistent with other data supplied.

Check the item amount, amend as required and re-submit claim.

9341

More information required. Either text must be keyed against a service or a time supplied for the voucher.

If using procedural items, include times and duration.

9364

Patient information provided is insufficient

Please check detail on patient file, run OPV check and re-submit.

9427

Service start date must be on or after the patient's date of birth and on or before the date of service and service end date.

Item is not covered for this patient at this date of service. Please raise new invoice and submit.

9601

Claim successfully transmitted and pended for further assessment by a Customer Support Officer. Claimant will be advised of outcome by mail.

Claim successfully transmitted and pended for further assessment by a Customer Support Officer. Claimant will be advised of outcome by mail

9602

This claim cannot be lodged through this channel. Please submit the claim via an alternative Medicare claiming channel.

Please issue patient an account receipt to claim through another channel e.g. at a Medicare office.

9605

Another Medicare Card may have been issued to the patient or the details you entered do not match those held by Medicare. Please update your records and resubmit the claim.

Please contact patient to obtain correct Medicare details.

9606

Another Medicare Card may have been issued to the claimant or the details you entered do not match those held by Medicare. Please update your records and resubmit the claim.

Please contact patient to obtain correct Medicare details.

9624

A subsequent consultation has been keyed and the date of service is after the referral expiry date

Get patient’s Medicare card number, item number and date of service and contact Medicare for advice.

9625

Claimant address needs to be updated with Medicare, Issue account/receipt for the claimant to submit via an alternative Medicare claiming channel.

Get patient to check address registered with Medicare, and amend patient file. Once done, resubmit.

9628

Referral or request required

Create new invoice, add referral and submit.

9630

Please check the request or referral details

Check and amend referral details as needed.

9631

Check if service self deemed

Edit the invoice to indicate service self deemed, and re-submit.

9632

Duplicate of service already paid. If not duplicate resubmit with appropriate indication.

Please check the service dates. If same

9633

A new Medicare card has been issued. Please update your records and ask the patient to use the new card number for any future claims.

Please contact patient or Medicare for updated card details.

9634

A new Medicare card has been issued. Please update your records and ask the claimant to use the new card number for any future claims.

Please contact patient or Medicare for updated card details.

9635

Check Servicing Provider. May not be able to provide the service for this item at date of service

Claimant must be over 15 years old. Please list parent or guardian on same Medicare card.

9641

A restrictive condition exists

Check the items being charged and review rules on MBS, as they may be incompatible to bill with each other. If unsure, contact Medicare for advice.

9646

The claim could not be located by Medicare.

Claim may have already been deleted. Please contact Medicare for advice on re-submission of claim.

9650

The card number and/or patient details submitted did not match Medicare checks. Please verify the details and resubmit with additional information if available.

There is a verification issue between patient details and Medicare details. Please check the details in the record, run an OPV check and contact Medicare if needed.

9655

An LSPN is required

Please contact Medicare to apply for an LSPN.

9656

LSPN invalid

Please contact Medicare to clarify your LSPN.

9662

Provider must contact Fund

Please check provider and patient details with the fund, and re-submit claim.

9666

Patient must contact Fund

Patient must check registered details with the fund.

9675

Current Medicare card has expired. Patient must contact Medicare as claims using this Medicare card may be rejected.

Current Medicare details for the patient are not up to date. The patient will need to organise for a new card.

9678

The service is not payable as an appropriate associated service is not present

Review MBS rules for items involved, and re-do claim.

9692

An Item Number must be supplied for every MBS service.

Please re-submit claim with valid item numbers.

9699

Item not covered for this patient at this date of service

Patient will need to check eligibility with Medicare.

9700

An incorrect item number appears to have been used/amount claimed does not match item number

Check claim and re-do to ensure correct details. Once done, submit.

9705

In some instances where two or more services are performed together, they are claimable under one item number. Please check the MBS for correct item and re-submit. If exceptional circumstances exist, please issue account/receipt notating reasons

Check the MBS for correct item and resubmit. If exceptional circumstances exist, issue an account receipt and get patient to claim through alternative channel e.g. Medicare office.

9765

Site not accredited for this service.

Site must contact Medicare to check registration and eligibility.

Reason Codes - 3 Digit Codes

Code

Description

Possible Solution

101

More details of service required to assess benefit

Check failed item number on claim has required additional information to be assessed e.g After hours, not duplicate service

120

Age restriction applies to this item

Confirm patients recorded age has been stored correctly in MediRecords. If patients age is correct then patient is not eligible for this service item

Check billing providers Medicare Provider Type from users preferences and that '"Include Referral for Medicare billing" has been checked to ensure future claims are assessed at the appropriate rate

141

No benefit payable for services performed by this provider

Provider may not be eligible to bill item, or need to renew registration with Medicare.

157

Service possibly aftercare - refer to provider

Please check the type of service given by the provider, and indicate aftercare if you re-submit the invoice.

159

Item associated with other service on which benefit payable

If the service is eligible for a Medicare benefit such as the service is not performed on the same occasion, not associated with the other service, not performed through the same incision, then for:

Online Claims – Check failed item to ensure required information has been included e.g start time, end time of service. You may also wish to include additional information with item in free text for item to be assessed correctly.

For certain MBS items, you can use the MBS Items Online Checker in HPOS to check eligibility before you lodge the claim. Log on to HPOS to see what items can be checked using the MBS Items Online Checker.

162

Benefit has been previously paid for this service

Medicare is viewing this service as a duplicate. Please follow the Managing Rejections article on steps to re-submit.

267

Service not payable - associated service not present

Please review the MBS rules regarding the item(s) and ensure that associated service items are included in re-submission.

307

Claim not paid - cardnumber not valid for date of service

Patient needs to check with Medicare for valid card details. Practice to update patient record with correct details for submission.

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